Porth's PrepU: Chapter 33- Disorders of Cardiac Conduction & Rhythm

A patient who will be undergoing a Holter monitor examination would be given which of the following instructions?

"Keep a diary of your activities and symptoms throughout the examination."

A nurse is observing a patient's cardiac status by telemetry monitoring. On the monitor, the P wave changes shape and an impulse frequently occurs before the next expected sinoatrial (SA) node impulse. The nurse interprets this rhythm by stating which of the following??

"The patient is experiencing premature atrial contractions (PACs)."

A nurse is caring for a patient with an average heart rate of 56 beats/min. The patient has no adverse symptoms associated with this heart rate and is receiving no treatment. Which of the following activity modifications should the nurse suggest to avoid further slowing of the heart rate?

"Avoid bearing down while having a bowel movement."

A nurse educator is explaining normal cardiac conduction and action potentials to a nursing cohort. How can the nurse best describe the term "slow response" (calcium current) to the students?

"It facilitates the entrance of calcium for the excitation-contraction mechanism that couples the electrical activity with muscle contraction."

A client arrives at the emergency room with dizziness and a near syncopal episode. Vital signs include a heart rate of 46 and blood pressure of 86/50. The cardiac monitors show regular rhythm as above. The client states his physician has been running blood work to rule out hypothyroidism. Based on the rhythm what does the nurse report the client has?

A symptomatic bradyarrhythmia

A client has been diagnosed with atrial flutter. What assessment finding does the nurse expect?

An atrial heart rate above 240 beats per minute

Paroxysmal supraventricular tachycardia arises from which of the following forms of reentry?

Arterioventricular (AV) nodal

Which of the following antidysrhythmic medications works by blunting the effect of sympathetic nervous system stimulation on the heart?

Beta blockers, such as metoprolol

Which of the following cardiac drug classifications decreases sympathetic outflow to the heart and is the is the cornerstone of therapy for catecholaminergic polymorphic ventricular tachycardia (CPVT)?

Beta-adrenergic blockers

Which of the following classifications of antiarrhythmic drugs act by inhibiting the potassium current and repolarization, thereby extending the action potential and refractoriness?

Class III

Nursing students who are studying for their upcoming cardiac exam are discussing how the heart could possibly continue to beat once removed from the body. One of the students explains that this phenomenon is directly related to automaticity. What is automaticity?

Inherent spontaneous action-potential

When a client has a recurrent, life-threatening arrhythmia originating either supraventricularly or ventricularly, ablation therapy is an option for treatment. What does ablation therapy do?

Isolates and destroys arrhythmogenic cardiac tissue

An 80-year-old male client arrives for his yearly physical without any complaints and following the checkup the physician explains that he has noted atrial fibrillation (AF) on the client's ECG. Before the physician can explain the disorder the client becomes very upset and states he thinks he is going to die. The physician explains that atrial fibrillation involves the top chambers of the heart and that:

Many people live with atrial fibrillation without even knowing they have it

Sick sinus syndrome is suspected in the case of a child who is postoperative following cardiac surgery. Which nursing action is the most appropriate?

Monitor the child's ECG for bradycardia

The nurse is caring for a 75-year-old client with end-stage emphysema who is having severe dyspnea. The nurse is evaluating the client's cardiac rhythms and notes a very irregular rhythm with P waves before most if not all the QRS complexes with a rate of 140. With closer inspection of the cardiac rhythm the nurse notes the P waves all look different. Which of the following most accurately describes this rhythm?

Multifocal atrial tachycardia

A client arrives at the doctor's office complaining of severe indigestion that has been intermittent; however, the pain is now constant and feels like a vise. The nurse does an ECG and recognizes that the situation is possibly emergent due to ST-segment elevation, which could indicate which of the following?

Myocardial infarction

A monitored hospitalized patient with a pulmonary embolism has been in atrial fibrillation (AF) for 4 days. The nurse observes the rhythm spontaneously convert to a normal sinus rhythm. Which of the following forms of AF is this?

Paroxysmal

The nurse is interpreting an electrocardiogram of a 65-year-old woman. Which should the nurse recognize as representing ventricular depolarization?

QRS complex

A group of nursing students is preparing for their final exams and are discussing cardiac arrhythmias. One of the students states that severe tachyarrhythmias would cause an increase in blood pressure. The group helps the student to understand that the opposite would more than likely occur because of which of the following?

Reduced diastolic filling time

A 28-year-old marathon runner comes to the clinic to obtain a physical exam for a new job. The nurse assesses a regular pulse rate of 52 beats per minute (bpm). Which of the following common dysrhythmias is the nurse aware this patient most likely has related to maintaining a large stroke volume?

Sinus brachycardia

A patient is seen in the emergency department complaining of chest discomfort, productive cough, and a fever of over 101°F for 3 days. The nurse performs an electrocardiogram and observes a rate of 110 beats per minute (bpm) with a normal P wave and a PR interval of 0.12 sec preceding each QRS complex. Which of the following does the nurse determine the rhythm to be?

Sinus tachycardia

Torsade de pointes is a specific type of polymorphic ventricular tachycardia in which the polarity of the QRS complex swings between positive and negative, often on a beat-to-beat basis. It is the result of the long QT syndrome and can cause sudden cardiac death. Which medication is not linked to torsade de pointes as a causative agent?

Tetracycline

A client is visiting the primary physician and appears extremely nervous. The intake nurse does his vital signs and notes an increase in both his heart rate and blood pressure. In an effort to better understand the client's presenting signs and symptoms the nurse asks the client about his concerns and the client states that the person who performed his pre-visit told him that he had an arrhythmia. Which is the most therapeutic response about cardiac arrhythmias that the nurse can make?

They can occur in diseased or healthy hearts

Which of the following heart block results in decreased cardiac output and fainting?

Third degree

In which of the following atrioventricular (AV) conduction disorders does the link between the atria and ventricles get lost, resulting in atrial and ventricular depolarization being controlled by separate pacemakers?

Third-degree AV block

Which type of pacing involves the placement of large patch electrodes on the anterior and posterior chest wall that can be connected by a cable to an external pulse generator?

Transcutaneous

Which of the following arrhythmias is considered to be the most fatal and requires immediate treatment?

Ventricular fibrillation

An intensive care unit nurse is caring for a client who suffered a myocardial infarction involving the anterior wall, and notes a change in the cardiac rhythm. The rhythm has a PR interval that does not change, but there are twice as many P waves as there are R waves. The nurse prepares for a temporary pacemaker insertion because the client has developed:

second-degree, type 2 AV block

The nurse is assisting a patient who had a myocardial infarction 2 days ago during a bath. The patient suddenly lost consciousness and the nurse was unable to feel a pulse. Cardiopulmonary resuscitation was begun and the patient was connected to the monitor with a gross disorganization without identifiable waveforms or intervals observed. Which of the following is a priority intervention at this time?

Immediate defibrillation

A nurse notes that the PR interval on a patient's electrocardiogram tracing is 0.22 seconds. Which of the following actions should the nurse take?

Monitor the patient and document the findings

ECG monitoring has been found to be more sensitive than a client's report of symptoms when identifying transient ongoing myocardial ischemia. Why is this?

Most ECG-detected ischemic events are clinically silent

Which of the following is the correct sequence for the generation of electrical impulses in the heart causing ventricular contraction?

SA node - AV node - bundle of His - bundle branches - Purkinje fibers

A male patient with a history of angina has presented to the emergency department with uncharacteristic chest pain. His subsequent electrocardiogram (ECG) reveals T-wave elevation. This finding suggests an abnormality with which of the following aspects of the cardiac cycle?

Ventricular repolarization

The nurse is caring for a client who suffered a massive myocardial infarction and is scheduled for an immediate permanent pacemaker insertion due to severe ischemia and damage to both SA and AV nodes. The nurse would expect which of the following?

Bradycardia with rate of 20-40

A patient's electrocardiogram monitor begins to sound an alarm and shows sustained ventricular fibrillation. The patient is unconscious and without a pulse. Which of the following priority interventions should the nurse take?

Defibrillate the patient

An exercise stress test challenges the heart to respond to the increased demands of exercise in a controlled and monitored environment. Not only do exercise stress tests show changes in heart rate, blood pressure, and perceived level of exercise, but they have also been found useful in determining what?

ECG ischemic-type ST-segment changes

A patient is scheduled to have a Holter monitor for 48 hours to detect disturbances in conduction. Which of the following actions is important for the nurse to tell the patient to ensure accuracy in correlating dysrhythmias with symptoms?

It is important to keep a diary of activities and symptoms

A 60-year-old client is being evaluated by the nurse practitioner for complaints of palpitations, dizziness, and near syncope. The client states that the symptoms seem to appear out of nowhere and go as quickly as they come. The nurse practitioner then attaches the client to a cardiac monitor and notes intermittent changes in heart rate from the mid-50s to the mid-120s. P waves are present although not before all QRS complexes. What does the nurse practitioner suspect?

Sick sinus syndrome

A 20-year-old college student, with no past medical history, arrives at the emergency room complaining of severe palpitations and dizziness that started this morning following a night of studying. The student is very upset that this is happening because the final exams are the following day. The cardiac monitor shows a heart rate of 110, regular rhythm with occasional premature ventricular complexes. The nurse explains to the student that this can happen in healthy hearts and is usually caused by stimulation of which of the following?

Sympathetic nervous system

A client with new onset atrial fibrillation (AF) is being admitted to the hospital for possible cardioversion. The initial vital signs include a heart rate of 160 and blood pressure of 90/60. The admission nurse anticipates the presence of a pulse deficit. To verify this finding which of the following would the nurse do?

With another nurse assess the apical and radial pulses simultaneously for one minute